482. Findings from the First Year of Population-Based Active Surveillance for Legionellosis -- United States, 2011
Session: Poster Abstract Session: Public Health
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Legionella, a bacterium spread via inhalation of bacilli in aerosolized water, can cause severe pneumonia. According to the passive national notifiable disease surveillance system (NNDSS), legionellosis incidence increased from 0.4 to 1.3 cases/100,000 population between 2000 and 2011. We present the first year of population-based active surveillance for legionellosis to assess incidence, disease severity and opportunities for prevention. Methods: We initiated active legionellosis surveillance within the Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network, which conducts surveillance on approximately 36 million people in 10 states. A confirmed case of legionellosis is defined as isolation of Legionella from respiratory culture, detection of Legionella antigen in urine, or seroconvesion. We analyzed 2011 case information collected from medical chart reviews. We used multiple imputation to replace missing values. We used 2011 postcensal estimates to adjust incidence rates for age and race. We analyzed unadjusted and adjusted odds of death for cases. We linked ABCs to travel data to assess location of residence during incubation. Results: ABCs identified 487 confirmed cases; 77% of patients were >50 years old and 62% were male. The age-adjusted incidence was 1.3 cases/100,000 population 1.2 cases/100,000 in whites and 2.8 cases/100,000 in blacks. Hospitalization occurred in 477 (98%) cases, ICU admission in 188 (39%) and death in 46 (10%). Case fatality among Blacks was similar to that among non-blacks (odds ratio 0.6, 95% CI 0.31.3). Most patients (61%) lived only in a private residence during disease incubation; 12 (4%) resided only in a healthcare setting and 94 (31%) reported some travel during their incubation period. Conclusion: Legionellosis incidence was similar in active and passive surveillance. Active surveillance elucidated racial disparities in incidence but not case fatality. Prevention efforts should ensure implementation of recommended measures to prevent legionellosis in healthcare settings along with studies to understand risks in the community. The underlying reasons for increasing incidence and racial disparity require further investigation.
Kathleen Dooling, MD, MPH1, Karrie-Ann E Toews, MPH1, Lauri Hicks, DO2, Laurel Garrison, MPH2, L. Rand Carpenter, DVM3, Erin Parker, MPH4, Susan Petit, MPH5, A. Thomas, MD, MPH6, Ruth Lynfield, MD7, Stepy Thomas, MSPH8, Robert Mansmann, MPH9, Benjamin White, MPH10, Greg Giambrone, MS11, Rene Najera, MT, MPH12 and Gayle E. Langley, MD, MPH2, (1)Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (2)Centers for Disease Control and Prevention, Atlanta, GA, (3)Tennessee Department of Health, Nashville, TN, (4)California Emerging Infections Program, Oakland, CA, (5)Connecticut Emerging Infections Program, New Haven, CT, (6)Department of Human Services, Health Services, Portlant, OR, (7)Acute Disease Investigation and Control, Minnesota Department of Health, St. Paul, MN, (8)Georgia Emerging Infections Program/Atlanta VA Medical Center, Atlanta, GA, (9)New Mexico Emerging Infections Program, Albuquerque, NM, (10)Colorado Department of Public Health and Environment, Denver, CO, (11)Emerging Infections Program, New York State Department of Health, Albany, NY, (12)Maryland Department of Health and Mental Hygiene, Baltimore, MD


K. Dooling, None

K. A. E. Toews, None

L. Hicks, None

L. Garrison, None

L. R. Carpenter, None

E. Parker, None

S. Petit, None

A. Thomas, None

R. Lynfield, None

S. Thomas, None

R. Mansmann, None

B. White, None

G. Giambrone, None

R. Najera, None

G. E. Langley, None

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